Asperger disorder is a form of pervasive developmental disorder characterized by persistent impairment in social interactions, repetitive behavior patterns, and restricted interests. Unlike autistic disorder, no significant aberrations or delays occur in language development or cognitive development. Asperger disorder is generally evident in children older than 3 years and occurs more often in boys.

Children with this disorder often exhibit a limited capacity for spontaneous social interactions, a failure to develop friendships, and a limited number of intense and highly focused interests. Although some people with Asperger disorder may have certain communication problems, including poor nonverbal communication and pedantic speech, many individuals have good cognitive and verbal skills. Bowler and colleagues have reported that, although people with Asperger disorder have fewer memories, the experiences of remembering are qualitatively similar in people with Asperger disorder compared with healthy control subjects.¹ Physical symptoms may include early childhood motor delays, clumsiness, fine motor difficulty, gait anomalies, and odd movements.

Individuals with Asperger disorder have normal or even superior intelligence and may make great intellectual contributions while demonstrating social insensitivity or even apparent indifference toward loved ones. Published case reports of individuals with Asperger disorder suggest an association with the capacity to accomplish cutting-edge research in computer science, mathematics, and physics. Although the deficits manifested by those with Asperger disorder are often debilitating, many individuals experience positive outcomes, especially those who excel in areas not dependent on social interaction.

Persons with Asperger disorder have exhibited outstanding skills in mathematics, music, and computer sciences. Many are highly creative, and many prominent individuals demonstrate traits suggesting Asperger syndrome. For example, biographers describe Albert Einstein as a person with highly developed mathematical skills who was unaware of social norms and insensitive to the emotional needs of family and friends.

Although normal language and cognitive development differentiate Asperger disorder from other developmental disorders, the severe social impairment associated with this condition overlaps with disorders such as high-functioning autism (HFA).

De Spiegeleer and Appelboom (2007) have pointed out that Asperger syndrome is an autism spectrum disorder. For clinical management purposes, Asperger disorder and HFA may be considered together. Impaired social skills are associated with several other conditions (eg, developmental learning disability of the right hemisphere, nonverbal learning disability, schizoid personality disorder, semantic-pragmatic processing disorder, social-emotional learning disabilities).

What Does It Mean to be Autistic

Autism is a brain disorder that too often results in a lifetime of impaired thinking, feeling, and social functioning — our most uniquely human attributes. Autism typically affects a person’s ability to communicate, form relationships with others, and respond appropriately to the external world. The disorder becomes apparent in children generally by the age of 3.

Autism (sometimes referred to as “classical autism”) is the most common condition in a group of developmental disorders known as the autism spectrum disorders.

Other autism spectrum disorders include:

• Childhood disintegrative disorder
• Asperger syndrome
• Rett syndrome
• Pervasive developmental disorder not otherwise specified (usually called PDD-NOS).

Experts estimate that three to six children out of every 1,000 will become autistic. Males are four times more likely to be autistic than females. Autistic girls with tend to have more severe symptoms and greater cognitive impairment.

Common Autistic Behaviors

Autism is characterized by three distinctive behaviors. Autistic children:

• Display problems with verbal and nonverbal communication
• Have difficulties with social interaction
• Exhibit repetitive behaviors or narrow, obsessive interests.

Some autistic people can function at a relatively high level, with speech and intelligence intact. Others have serious cognitive impairments and language delays, and some never speak.

In addition, autistic individuals may seem closed off and shut down, or locked into repetitive behaviors and rigid patterns of thinking. An autistic infant may avoid eye contact, seem deaf, and abruptly stop developing language. The child may act as if unaware of the coming and going of others, or physically attack and injure others without provocation. Autistic infants often remain fixated on a single item or activity, rock or flap their hands, seem insensitive to burns and bruises, and may even mutilate themselves.

The Importance of Autism Aducation

Early and intensive autism education can help children grow and learn new skills. The goal of this education is to help with the difficult symptoms of autism in a child and to improve the child’s skills that help him or her talk, interact, play, learn, and care for his or her needs.

Where to Find Education for those with Autism

For every child eligible for special programs, each state guarantees special education and related services. The Individuals with Disabilities Education Act (IDEA) is a federally mandated program that assures a free and appropriate public education for children with diagnosed learning deficits. Usually, children are placed in public schools, and the school district pays for all necessary services. These will include, as needed, services provided by the following:

• Speech therapists
• Occupational therapists
• School psychologists
• Social workers
• School nurses
• Aides.

By law, the public schools must prepare and carry out a set of instruction goals or specific skills for every child in a special education program. The list of skills is known as the child’s Individualized Education Program (IEP). The IEP is an agreement between the school and the family on the child’s goals. When your child’s IEP is developed, you will be asked to attend the meeting. Several people will be at this meeting, including a special education teacher, a representative of the public schools who is knowledgeable about the program, other individuals invited by the school or by you (you may want to bring a relative, a child care provider, or a supportive close friend who knows your child well). Parents play an important part in creating the program, as they know their child best. Once your child’s IEP is developed, a meeting is scheduled once a year to review your child’s progress and to make any alterations to reflect his or her changing needs.

If your child is under three years of age, he or she should be eligible for an early intervention program; this program is available in every state. Each state decides which agency will be the lead in the early intervention program. These services are provided by workers qualified to care for toddlers with disabilities and are usually in the child’s home or a place familiar to the child. The services provided are written into an Individualized Family Service Plan (IFSP) that is reviewed at least once every six months. The plan will describe services that will be provided to the child, but will also describe services for parents to help them in daily activities with their child and for siblings to help them adjust to having a brother or sister with an autism spectrum disorder.

Since autism was first added to the psychiatric literature fifty years ago, there have been numerous studies and theories about its cause. Researchers still have not reached agreement regarding its specific causes. First, it must be recognized that autism is a set of a wide variety of symptoms and may have many causes. This concept is not unusual in medicine. For instance, the set of symptoms that we perceive of as a “cold” can be caused by literally hundreds of different viruses, bacteria, and even our own immune system. Autism is, undoubtedly, a biologically-based disorder. In the past, some researchers had suggested that autism was the result of poor attachment skills on the part of the mother. This belief has caused a great deal of unnecessary pain and guilt on the part of the parents of autistic children, when in fact, the inability of the individual with autism to interact appropriately is one of the key symptoms of this developmental disorder.

In support of a biological theory of autism, several known neurological disorders are associated with autistic features. Autism is one of the symptoms of these disorders. These conditions include tuberous sclerosis (an inherited disorder), the fragile X syndrome, cerebral dysgenesis (abnormal development of the brain), Rett syndrome, and some of the inborn errors of metabolism (biochemical defects). Autism, in short, seems to be the end result or “final common pathway” of numerous disorders that affect brain development. In general, however, when clinicians make the diagnosis of autism, they are excluding the known causes of autistic behaviors. However, as the knowledge of conditions that cause autism advances, fewer and fewer cases will be thought of as being “pure” autism and more individuals will be identified as having autism due to specific causes.

There is a strong association between autism and seizures. This association works in two ways: First, many patients (20% to 30%) with autism develop seizures. Second, patients with seizures, which are probably due to other causes, may develop autistic-like behaviors. One special and often misunderstood association between autism and seizures is the Landau-Kleffner Syndrome. This syndrome is also known as acquired epileptic aphasia. Some children with epilepsy develop a sudden loss of language skills–especially receptive language (the ability to understand). Many often also develop the symptoms of autism.

These children often, but not always, have a characteristic pattern of electrical brain activity seen on EEG (electroencephalogram) during deep sleep called electrographic status epilepticus during sleep (ESES). The usual age of onset of language loss or regression is around four years of age, which makes the Landau-Kleffner syndrome distinguishable from autism on these grounds, in that autism usually is first exhibited in younger children. However, in recent years, some children (very, very few) who did not exhibit overt (observable) seizures were found to have Landau-Kleffner syndrome.

The importance of these findings is that, although rare, the Landau-Kleffner syndrome can resolve spontaneously and in some cases can be treatable with prednisone, a steroid medication related to cortisone. This association between the Landau-Kleffner syndrome and autism has led many clinicians and families to search for the typical EEG pattern (ESES) in autistic individuals. This unusual EEG pattern is seen only in deep sleep, which usually requires prolonged recordings of up to 12 hours. Many, many autistic children and adults will display some abnormalities on their sleep EEG, but probably very few have true Landau-Kleffner syndrome that will respond to treatment.

It must also be noted that prednisone, in the very high doses used to treat Landau-Kleffner syndrome, almost invariably produces side effects, which may include weight gain, high blood pressure, diabetes, growth failure, stomach ulcers, irritability, destruction of the hip joint, and susceptibility to infectious disease (suppressed immune system). While most of these side effects are reversible, some of the complications of high dose prednisone therapy can be irreversible and even fatal.

Other treatments ranging from common anticonvulsant therapy to surgery have been proposed and are being tried for Landau-Kleffner syndrome. It is difficult to evaluate the true effects of any treatment for Landau-Kleffner syndrome due to the high rate of spontaneous resolution of symptoms (remission).